Claims Adjuster for medical negligence claims, ensuring high standards of service to clients. Managing claims from cradle to grave with remote working flexibility.
SE
Hybrid Claims Associate – Workers Compensation, Multi State Jurisdiction
Posted 3 months ago
About the role
- Claims Associate analyzing reported lower-level workers compensation claims at Sedgwick. Working in a hybrid role based in Michigan or Ohio, ensuring compliance with company standards.
Responsibilities
- Analyze reported lower-level workers compensation claims to determine benefits due
- Ensure ongoing adjudication of claims within company standards and industry best practices
- Adjust medical-only claims and minor lost-time workers compensation claims under close supervision
- Support other claims representatives, examiners, and leads with larger or more complex claims as necessary
- Process workers compensation claims determining compensability and benefits due; monitor reserve accuracy, and file necessary documentation with state agency
- Communicate claim action/processing with claimant, client, and appropriate medical contact
- Ensure claim files are properly documented and claims coding is correct
- May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims
- Maintain professional client relationships
Requirements
- High school diploma or GED required
- Licenses as required
- One (1) year of general office experience or equivalent combination of education and experience required
- Claims industry experience preferred
Benefits
- Flexible Work Schedule
- Referral Incentive Program
- Opportunity to work from home
- Career development and promotional growth opportunities
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day 1
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